Procedure Code and Unit of Service:
H0031 – Mental Health Assessment by a Non-Mental Health Therapist – per 15 minutes
Mental Health Assessment Guidelines from Medicaid
Mental Health Assessment means providers listed below, participating as part of a multi-disciplinary team, assisting in the psychiatric diagnostic evaluation process defined in Chapter 2-2, Psychiatric Diagnostic Evaluation. Through face-to-face contacts with the individual, the provider assists in the psychiatric diagnostic evaluation process by gathering psychosocial information including information on the individual’s strengths, weaknesses and needs, and historical, social, functional, psychiatric, or other information and assisting the individual to identify treatment goals. The provider assists in the psychiatric diagnostic reassessment/treatment plan review process specified in Chapter 2-2 by gathering updated psychosocial information and updated information on treatment goals and assisting the client to identify additional treatment goals. Information also may be collected through in-person or telephonic interviews with family/guardians or other sources as necessary. The information obtained is provided to the individual identified in Chapter 2-2 who will perform the assessment, reassessment or treatment plan review.
Who:
The following individuals when under the supervision of a licensed mental health therapist identified in Chapter 1-5, A. 1:
1. licensed social service worker or individual working toward licensure as a social service worker in accordance with state law;
2. licensed registered nurse;
3. licensed ASUDC, CASUDC, SUDC, CSUDC or ASUDC-I or SUDC-I;
4. licensed practical nurse; or
5. registered nursing student engaged in activities constituting the practice of a regulated occupation or profession while in training in a recognized school approved by DOPL, or an individual enrolled in a qualified substance use disorder education program, exempted from licensure in accordance with state law, and under required supervision.
Although these individuals may perform this service and participate as part of a multi-disciplinary team, under state law, qualified providers identified in Chapter 2 -2 are the only providers who may diagnose a behavioral health disorder and prescribe behavioral health services determined to be medically necessary to treat the individual’s behavioral health disorder(s).
Limits:
1. This service is meant to accompany the psychiatric diagnostic evaluation (see Chapter 2-2). If a psychiatric diagnostic evaluation (assessment or reassessment) is not conducted after this service is performed, this service may be billed if all of the documentation requirements in the ‘Record’ section are met and the reason for non-completion of the psychiatric diagnostic evaluation is documented.
2. If the provider conducting the psychiatric diagnostic evaluation defined in Chapter 2-2 obtains all of the psychosocial information directly from the client, only that service is billed. The provider does not also bill this service.
Time and Unit calculation
The following time rules apply for converting the duration of the service to the specified number of units:
Less than 8 minutes equals 0 units;
8 minutes through 22 minutes of service equals 1 unit;
23 minutes through 37 minutes of service equals 2 units;
38 minutes through 52 minutes of service equals 3 units;
53 minutes through 67 minutes of service equals 4 units;
68 minutes through 82 minutes of service equals 5 units;
83 minutes through 97 minutes of service equals 6 units;
98 minutes through 112 minutes of service equals 7 units; and
113 minutes through 127 minutes of service equals 8 units, etc.
CPT code H0031 – Maximum fee – $125.00 per assessment
Description of Service – In-depth assessment, new patient, mental health , In-depth assessment, new patient, mental health—telemedicine.
Limitation – Medicaid reimburses one in-depth assessment, per recipient, per state fiscal year.* An in-depth assessment is not reimbursable on the same day for the same recipient as a bio-psychosocial evaluation. A bio-psychosocial evaluation is not reimbursable for the same recipient after an in-depth assessment has been completed, unless there is a documented change in the recipient’s status and additional information must be gathered to modify the recipient’s treatment plan.
Tips for usage
HSD/Medicaid will use this code for PSR only. Use modifier U8.
** For multi-disciplinary team, use modifier HT.
** For substance abuse assessment, use modifier HF.
** For substance abuse/mental health assessment, use modifier HH
Eligible Provider
** Bachelor’s degree in human servicesrelated field and a combination of relevant education, training, and experience totaling four years; or
** LADAC; or
** Masters Degree in human servicesrelated field.
NOTE: Completed assessment must be signed and dated by staff completing the assessment and, as appropriate, a masters level supervisor.
